NON-TEACHING STAFF APPLICATION FORM

Position applied for :

Please affix
Department : recent
Passport size
Have you applied for a post : Photograph
at Karunya earlier; if so, for
What post and when

(Applications should be complete in all respects; incomplete applications will not be considered)

A) PERSONAL DATA: E-mail Id: …………………………………………….

1. Name (in block letters) Mr. / Mrs. / Ms.…………………………………………………………………

2. Mailing Address (in block letters) Ph.No.(with STD Code) Mob.No.

…………………………………………………………………………………………………………………
………….…………………………………………….……………………… Pin code …..….…………...

Permanent Address (in block letters) Ph.No.(with STD Code) Mob.No.

…………………………………………………………………………………………………………………

Taluk ………………………………..….District …………………………………Pin Code……………….

3. Date of Birth ……………………….. 4. Religion ………………………. 5. Caste ……………………..

(Certificate to be enclosed) OC / BC / MBC / SC / ST

(For official purposes only)

Remarks of the Selection Committee: Date of Interview:

. ……………………………………. …………………………………..… …………………………………………..

. ……………………………………. …………………………………..… …………………………………………..

……………………………………. …………………………………..… …………………………………………..

. ……………………………………. …………………………………..… …………………………………………..

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6. Marital Status : Married / Single
7. Children & Other Dependents:
Name Relationship Age
………………………………………. …………………………………. ………………

………………………………………. …………………………………. ………………

………………………………………. …………………………………. ………………

8. Father’s / Guardian’s Name …………………………………………………………………………………

9. In case of emergency the person to be notified:

Name ……………….. …………………………….. Relationship ………………….……………………

Address ………………………………………………………………………………………………………..
……………………………………………Pin Code …………..……. Ph.No. …………………….….….
B) PHYSICAL DATA:

10 a) Height: …………… Cm b) Weight ……………Kg c) Blood group …………………

d) Eye sight (wearing spectacles) Yes / No. If yes, power …..………………………………………….

11. Have you any physical handicaps?

a) Sight ( ) b) Hearing ( ) c) Feet ( ) d) Hand ( )
If so, kindly provide details with regard to the extent it has hampered your normal working
………………………………………………………………………………………………………………
………………………………………………………………………………………………………………
12. Have you had any major operations / illness during the past 3 years? If so, give details:
………………………………………………………………………………………………………………
………………………………………………………………………………………………………………
C) ACADEMIC QUALIFICATIONS:

13. Kindly start with your highest qualification and list up to SSLC

Full time
/ Part Main Subject Class
Degree / Name of College / University / Year of Perce
time / taken as /
Diploma Corresp School & Location Location Passing ntage Rank
Specialisation
ondence
         
   
         
   
         
   
         
   

14. Kindly furnish details of Scholarship / Special merit awards?

a. …………………………………………………………………………………………………...………………
b. ………………………………………………………………………………………………...…………………

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15. Kindly provide details on your extra-curricular activities / hobbies / fields of interest during your
College days, including awards received / knowledge of music.

a) ____________________________________ b) __________________________________

c) ____________________________________ d) __________________________________

D) PROFESSIONAL INFORMATION:

16 Previous Working Experience (Enclose photocopy of certificates)

Name of Duration Reasons for

From To Years Months Designation
Institution & Place Leaving
(dd-mm-yyyy) (dd-mm-yyyy)
         

         

         

         

Total Experience: ________________

17 Salary Structure:

Your present salary structure or last pay drawn (Last pay certificate may be produced at time
of interview)

a) Basic pay : `……………….

b) Dearness Allowance : `……………….
c) Additional D.A. : `……………….
d) H.R.A. : `……………….

e) C.C.A. : `……………….

f) Any other : `.………………

-------------------------
Total Salary per month :`
-------------------------

Expected Salary : Basic pay ` _____________

Total Salary ` _____________

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E) GENERAL INFORMATION:

18. Languages which you are proficient with:

Speak Read Write

..………………………………. .………………………………. ……………………………………

..………………………………. .………………………………. ……………………………………
..………………………………. .………………………………. ……………………………………

19. Do you (a) Smoke: Yes / No (b) Consume Alcohol: Yes / No (c) Other habits

20 If offered the post, time required to join …………………………………………………….

F) REFERENCES:

21 Please give the names of two referees acquainted with your attainments. If related give details of
relationship.
a. Name ……………………………………………..
………………………………………………………….. Address:
……………………………………………………………………………………………………….

b. Name
………………………………………………………………………………………………………..
Address: …………………………………………………………………………………………………….

c. Additional information, if any (attach separate sheet) :………………………………………………...

22 I hereby certify that the above information furnished by me is true and that I agree to appear for
an interview / test if required to do so.

Date: Signature

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 ANNEXURE TO BE FILLED BY CANDIDATES AS APPLICABLE

Karunya Institute of Technology and Sciences (Deemed to be University), besides

imparting vocational guidance also aims to inculcate in its students the values and discipline.
To enable us in this our endeavour, we would like to elicit the following information from you
which may be filled up prayerfully.
_________________________________________________________________________________

A. Your Church affiliation

B. Are you a member of any Christian organisation? If so, could you please describe your role in the
organisation?

C. Have you had a personal experience of salvation? If yes, Please describe briefly.

D. What do you know about different aspects of the Jesus Calls ministry? How have you been
associated with it? Are you or your family members Partners?
a) JCP - Yes / No b) KET - Yes / No. c) BETHESDA - Yes / No. d) Young Partner? Yes / No.

E. Would you be willing to uphold the aims and objectives of the Karunya Institute of Technology and
Sciences (Deemed to be University), if you are appointed in this Institution?

Date: Signature